It doesn’t take much to provoke bleats from doctors about being hard done by and overworked.

“My plumber with no student loans, no education, and accepting only cash payments has an easier and more profitable career. Yes, medicine is a very altruistic career, but altruism doesn’t pay for college, graduate schools, mortgages, food, etc. The CEO of United Healthcare with $23,000,000 in earnings last year couldn’t give a hoot about the altruism in medicine.” Says one respondent.

And, “Our salaries are because we work our butts off, give up time with our families to take calls and work weekends, deal with stress most business people could never imagine (telling someone their mom has died or is dying, etc.), studied hard AND LONG (anyone get a chance to really enjoy their 20s or even early 30s? Didn’t think so), and we should never have to apologize for being successful through diligence and sacrifice.”

The Other Side

The other side to this is being in a group that owns it’s own imaging department and having mandatory meetings every month or two where the Chief Medical Officer and administration tells us what codes to use to assure the study doesn’t get denied by the insurance company, and cajoles us into ordering as many studies as possible.

Or the coders come and tell you how to “buff” the chart i.e. maneuver the documentation to allow one to charge the highest possible code - even if it’s something totally trivial like a sore throat. So the charge is absurdly overpriced - but it’s OK, you’ve put in enough (unhelpful) documentation to justify a 99214 charge.

Or why does the Institute of Medicine find it necessary to recommend in its guidelines, no “consultant fees”? Could they be thinking of us poor dumb schmuck, grunts being willing to pretend to be  “thought leaders” and regurgitate the Daiichi-Sankyo advertising garbage the reps give us to present at a “Physician Opinion and Discussion” (P.O.D.) lunch meeting. Where we shoot the breeze, eat the lunch they provide, and get paid $600 - which I see as a thinly disguised coercion to steer us away from the opposition’s products (Norvatis’s Diovan and Exforge), and to their products, Benicar and Azor.

So which is the true picture? The downtrodden, over-worked victim? Or the avaricious conniving manipulator?

Probably a bit of both!   ”Order the damn MRI” 

Will it be Chelsea Clinton, with her vegan faire and gluten free wedding cake at her very overpriced wedding?

Or will it be the “depravity” of competitive eating - in which competitors have increased their ability to scarf down hot dogs from 25 in ten minutes, ten years ago, to 68 in a recent record breaking bortz out at Coney Island according to Slate.com.

Then there’s strife in the homestead and the husband walks out - or is thrown out, I never quite gathered which. She’s in spitting bullets. “He only wants the Cialis for his girl friend”.

The antidote to this, needed to be an effective adult are, 3 perceptions and 4 skills according to the program ‘Developing Capable Young People’ (DCYP). The perceptions are:

• I am capable
• I contribute in a meaningful and significant way
• I have power or influence over my own life

The skills are

• Understanding your own feelings
• Communication skills - to interact/negotiate with others
• Ability to adapt and be functional in systems
• Judgment                                                                                                                                                         

(more…)

My sister just gave me ‘Blink’ - subtitled “the power of thinking without thinking”.

It’s all about how we make decisions about things, and particularly instant decisions - or “thin slicing” as he calls it. Some subliminal process is going on where we are thinking about, and making a judgment about, someone or something without realizing it.

He sites numerous examples of where this occurs - by art critics, by cops in arrest situations, in music auditions and many other situations. I think this may be the explanation for the little voice in my head that is telling me what is wrong with someone, or more particularly, that just pops the name of a medicine into my mind, for no apparent logical reason.

I will be sitting before a patient and suddenly the name Zoloft or Coreg or Topomax will suddenly come to mind - well before I have gone through the whole rigmarole of history and examination and then computing it all for the “assessment and plan”.

Another factoid he sites is how you can make a fairly good assessment of a person, not by meeting them, but by looking at their surroundings.

He sites a study where the personality of students was remarkably accurately assessed by looking at their rooms - if they are anything like some of the student rooms I have seen in my time, this could be a dangerous thing to do.

The relevance of this to the practice of medicine, is that it vindicates what is said about the benefit of the lost art of house calls. That you gather all sorts of information about the patient that you would not have if they just come to the office and you don’t see their home environment.

You see their wound infection’s not clearing up because of the unsanitary conditions. That they’re not getting any rest because they’re next to the interstate. That they’re fighting with their wife. The pile of pizza boxes and empty fridge indicate a crappy diet. That the garbage is cram full of beer cans. That there are numerous loose rugs and obstacles that will lead to falls - and so on, in your Sherlock Holms-ian way.

Finally he discusses the conundrum of how it’s not the degree of skill or how many mistakes a doctor makes that predicts if he/she will get sued.

He talks about a study of conversations between surgeons and patients - that were dickered with so that you couldn’t even hear the words - just the tone of voice.

It would appear it is the doctor who adopts a dominant tone that incites patients to sue him or her.

So the idea of redesigning them is kind of sacrilegious - but that’s what the American Academy of Pediatricians wants.

                                                                                                                                                                      An Icon  

(more…)

Maybe there;s a solution to this too many people on the bench/CRS?  (more…)

Mrs.Gagg always claims that she’s cursed by Murphy (you know “anything that can go wrong will”) - and needs to kiss the Blarney stone to get cured (it’s on the itinerary). But I fear I am destined to the same for having failed to pass on an “Irish Luck” e-mail.

I didn’t realize it in my naivety, but it’s National Friendship Week, and some philanthropist somewhere sent me this opportunity to have a wish come true - within 3 hours if I send this to 20 other people. Together with some sound advice like “love like you’ve never been hurt” and “dance like nobody’s watching”.

But “you had better send it on” warns the anonymous presence. “If you delete this you will have one year of bad luck”.

This e-mail is a turgid, apocryphal story about how, as a boy, Alexander Fleming (the discoverer of penicillin) saved some other boy from a peat bog in Scotland. The boy he saved supposedly was Winston Churchill - and supposedly his farther (Lord Randolph Churchill) then paid for Fleming to go to medical school, so penicillin was invented - and then to cap the sentimentality, supposedly Winston’s life was saved by penicillin when he got pneumonia.

The problem  is that it is all pure bullshit. I just happen to be reading a detailed and  authoritative biography on Fleming (Penicillin Man by Kevin Brown). In reality, when Churchill got pneumonia after attending the conference in Tehran in 1943 to set up Operation Overlord, his physician, Lord Moran chickened out on using penicillin as it was not very well tried and tested at that stage. He was in fact saved by sulphonamides - but the newspapers, in their enthusiasm for penicillin mania “reported Churchill’s recovery, but claimed it was due to penicillin”

Those imaginative journalists also came up with the story of how Fleming had “twice saved the Prime Ministers’ life”, with “Fleming or his farther having saved Churchill from drowning as a boy”. “Neither story was true, but put together they made good copy, and like many good stories, live on as urban myth” notes Brown.

Mrs. Gagg, ever vigilant that I don’t put my foot in my mouth, tells me that the website ‘Snoops’ confirms that the story in the e-mail is not true.

The point of my comment is not to be a smart-ass about catching the error, but to ask who are the dorks sending out these hideously sentimental “Round Robin” e-mails that seem to arrive in my in box all too often - with their threats of misfortune if you den’t send them on?

Here’s a picture of a couple of fellowes who obviousely DID pass on the e-mail.

I always thought the story was that a petri-dish growing Staphylococcus

Aureus was left out on the bench, and the lab assistant, and not Fleming, noted there was no growth where a mold had grown. But apparently that’s not true, according to the book ‘Penicillin Man’ by Kevin Brown.                                                                                                               Some Perks of the Drug (more…)

Ignoranus: A person who’s both stupid and an asshole.

Bozone: The substance surrounding stupid people that stops bright ideas from penetrating.

Inoculatte: To take coffee intravenously when you are running late.

Osteopornosis: A degenerate disease.

Decafalon: The grueling event of getting through the day consuming only things that are good for you.

Arachnoleptic Fit: The frantic dance performed just after you’ve walked through a spider web

Adiposure: Someone who exaggerates their weight at the beginning of a diet so his “loss” will be more impressive.

Contestosterone: The hormone that accounts for why 14 of 15 all time top ‘Style Invitational’ losers are male. Females instead have the hormone havealifeogen.

Or some true neologisms from the past:

Coffee: The person on whom one coughs

Flabbergasted: Appalled at discovering how much weight one has gained.

Abdicate: to give up all hope of ever having a flat stomach.

Lymph: To walk with a lisp.

Flatulence” An emergency vehicle that picks up someone who has been run over by a steamroller.

Testicle: A humorous question in an exam.

Rectitude: The formal dignified bearing adopted by a proctologist

Pokemon: A Rastafarian proctologist.

Circumvent: An opening in the front of boxer shorts worn by Jewish men.